Surviving a Heart Attack - After the First Day

What should happen after you've gotten through the acute heart attack?

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Having a heart attack (myocardial infarction, or MI) is always a life-changing event.

The acute MI itself, of course, is a time of great danger, and can lead to severe heart damage, cardiac arrest, and even death. A heart attack is always a medical emergency, and surviving one in good health depends quick action both by you and your doctor.

But with modern medicine and some luck - especially if you and your doctors acted quickly during those first few critical hours - you have a very good chance of living for a long time in relatively good or even excellent health.

What Should Happen Next?

Once the medical emergency has been dealt with, your work is just beginning. There is a lot you must do to optimize your cardiovascular health over the long-term.

Unfortunately, this is where you and your doctors are most likely to drop the ball. In the rush to discharge the "uncomplicated" heart attack patient, usually a couple of days after hospital admission, vital steps can be neglected.

In this series of brief articles, we will review the important steps that you need to take to assure that, now that you have survived the acute phase of your MI, you will become a long-term survivor as well. If you or a loved one has had a heart attack, you need to make sure that your doctors pay careful attention to all these steps.

Keep in the forefront of your mind that your acute MI was most likely caused by a sudden rupture of an atherosclerotic plaque in one of your coronary arteries.

The rupture produced a blockage in the artery, and caused some or all of the heart muscle supplied by that artery has been permanently damaged.

So, now that you've successfully negotiated the first 24 hours of your heart attack, you know at least three things about yourself you may not have known before.

Three Facts About Yourself You May Not Have Known Before:

  1. You have coronary artery disease (CAD), which is a chronic, progressive medical condition.
  2. Some portion of your heart muscle has been damaged, and your remaining normal heart muscle is working overtime to pick up the slack.
  3. By virtue of the fact that you now have scar tissue on your heart muscle, you may be at higher-than-normal risk for sudden death from heart arrhythmias.

Knowing these things, it should be obvious that you've still got a lot of work ahead of you.

Here's What You And Your Doctor Need To Do Now:

Given these three facts, there are three main things you and your doctor now need to focus on. Be sure to follow each of these three links:

1. Take steps to prevent another heart attack, which means reducing immediate as well as long-term risks.

2. Accurately assess the amount of heart damage that has already occurred, and take steps to prevent the onset of heart failure.

3. Assess your risk of sudden death, and institute preventive therapy if necessary.

You will need to partner with your doctor, in each of these three areas of focus, to assure your long-term survival after a heart attack.

As you do so, you may find this Post-Heart-Attack Checklist helpful. Review each of these steps with your doctor, to make sure you are both hitting the essential steps.


Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:2999.

O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:529.

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